Annual Message to the Community - Select Health of South Carolina

Transcription

First in Quality
First in Care
Select Health of South Carolina
2016 Annual Message
to the Community
Select Health of South Carolina
is headquartered in North
Charleston, South Carolina.
SELECT HEALTH of South Carolina
has provided access to high-quality health care for South Carolinians
for more than 20 years through
Select Health’s First Choice health
plan. First Choice is the state’s oldest health plan as part of South
Carolina’s Medicaid program,
Healthy Connections. First Choice
serves more than 340,000 members in all 46 counties of the state
and is the top-rated Medicaid
health plan in South Carolina, according to the National Committee
for Quality Assurance’s (NCQA’s)
Medicaid Health Insurance Plan
Ratings 2015–2016, as it has been
since 2010. (The South Carolina
Department of Health and Human
Services [SCDHHS] uses other
criteria for evaluating and ranking the performance of health
plans serving Medicaid beneficiaries.) First Choice is the first health
plan in South Carolina to earn
NCQA’s Multicultural Health Care
Distinction, which recognizes our
commitment to delivering culturally
competent health care.
Select Health also offers First
Choice VIP Care Plus in 39 counties of South Carolina. As a Healthy
Connections Prime plan, First
Choice VIP Care Plus aims to improve care coordination for seniors
who are eligible for and utilize both
Medicare and Medicaid benefits.
Select Health is part of the
AmeriHealth Caritas Family of
Companies, one of the nation’s
leaders in health care solutions for
those most in need. Operating in 19
states and the District of Columbia,
AmeriHealth Caritas serves more
than 5.3 million Medicaid, Medicare
and Children’s Health Insurance
Program (CHIP) members through
its integrated managed care products, pharmaceutical benefit
management and specialty pharmacy services, behavioral health, and
other administrative services. 2016 Annual Message to the Community | iii
About Us
First-rate health care in
South Carolina
Table of
Contents
iii
First-rate health care in South
Carolina
2
First in leadership
4
Our members, first and foremost
7
Great care is the first step in
managing costs
8
First steps to care
9
Care before and after the first
breath
10 Putting children’s health first
14
Achieving quality standards by
putting care first
16
First things first: Identifying
barriers to care
19 Chosen first by South Carolina
providers
20
Firsthand knowledge in caring for
our members
22 Understanding is the first step in
care management
24
First listening, then achieving
26 To be an inspiration, you must
first set an example
We help people get care, stay well
and build healthy communities.
Care is the heart of our work.
Welcome
First in leadership
Message from Paul A. Tufano:
As part of the AmeriHealth
Caritas Family of Companies,
Select Health of South Carolina lives
the company’s core values every
day. We recognize the inherent
worth of each individual and understand the profound connection
between quality of life and quality
of care. It is what drives our mission
to identify and remove barriers so
our members across the state can
access the right health care at the
right time.
Our dedication to delivering hope
and healing stretches back more
than 30 years. It grew out of a
simple observation in a West
Philadelphia hospital where lowincome community members were
increasingly turning to the emergency room as their primary source
of care. Today, AmeriHealth Caritas
serves more than 5.3 million members in 19 states and the District of
Columbia, but we have never lost
sight of our humble beginnings.
Our roots are deep in the communities we serve, and we have an
extensive history of partnering with
local organizations and providers to
address the needs of our members
right where they live. In collaboration with state, business and
community groups, we are bridging
the gaps in health care access, innovation and technology to ensure
quality health care and services are
available to everyone, while at the
same time working to reduce health
care costs.
2 | Select Health of South Carolina
At AmeriHealth Caritas, we travel
with our members on the road to
wellness. By keeping our members at the center of all we do, we
are able to deliver compassionate
care that honors the uniqueness
of each member. Our members’
needs are the stepping stones to
every decision we make. Through
our commitment to excellence and
strong partnerships, we facilitate
coordination of physical and behavioral health, as well as pharmacy
benefits and social supports, and
we provide a clear path to the best
possible health outcomes for our
members.
I believe caring for our members is
not just a responsibility, but also a
glorious opportunity.
Paul A. Tufano
Chairman and Chief Executive Officer,
AmeriHealth Caritas Family of
Companies
Welcome
Message from J. Michael Jernigan:
Message from Rebecca Engelman:
More than 20 years ago, Select Health began a journey of health care transformation. We were the first
Medicaid health plan in South Carolina, and today we
have the privilege of serving the most South Carolina
Medicaid members through First Choice. Backed by the
30-year history of our parent company, AmeriHealth
Caritas, Select Health is a recognized leader among
South Carolina’s managed care plans.
Our most valuable resource is our people. Select
Health associates have always been passionate about
keeping our plan members healthy, and I’m so gratified to work with such a committed team of people
who breathe life into our mission every day.
AmeriHealth Caritas has defined, and continues to define, an integrated business model that advances quality
and accessibility to care while further improving health
outcomes and efficiency. We work collaboratively with
states and other partners to identify innovative solutions that improve access to care, reduce administrative
complexities and contain rising health care costs. Our
fresh approach to engaging members, managing care
and developing government partnerships has helped
improve millions of lives.
As a trusted partner in health care solutions, Select
Health continues to focus on our mission of putting care
at the heart of our work. As part of AmeriHealth Caritas,
we are committed to helping people get care, stay well
and build healthy communities. With the tremendous
support of our associates, dedicated providers and invaluable community partners, we are forming new and
advanced approaches to care to keep South Carolina
healthy for generations to come. I am incredibly proud
to be part of Select Health and AmeriHealth Caritas, and
I look forward to seeing continued improvements in the
state’s health outcomes.
Our partnerships with the South Carolina Department
of Health and Human Services and more than 10,000
providers statewide are critical components of our
ability to improve the overall health and wellness of
our members. Together, we work to provide members
with high-quality care, and it is clear that our efforts
are making a difference.
First Choice is the top-rated Medicaid health plan in
the state, according to NCQA, and has been since
2010. Our top rating is based on strong results from
the Healthcare Effectiveness Data and Information
Set (HEDIS®), a tool that measures performance on
important dimensions of care and service, as well as
the Consumer Assessment of Healthcare Providers
and Systems (CAHPS®) survey, which measures
members’ satisfaction with their overall health care
experience. First Choice is also the market share
leader and preferred plan among South Carolina’s
Medicaid beneficiaries and maintains the highest levels of enrollment, transfer-in rate and retention rate.
Select Health will continue providing innovative health
care solutions with our members in mind and will
work to do even more to help members get the care
they need to be healthy.
Sincerely,
Sincerely,
J. Michael Jernigan
Regional President, AmeriHealth Caritas, and
Founder, Select Health
Rebecca Engelman
Market President, Select Health
2016 Annual Message to the Community | 3
Care Management
Our members, first
and foremost
People with chronic conditions
often have multiple health concerns,
see several providers and take numerous medications. Our complex
care management program provides
extra support for these health plan
members. The program assesses
physical and mental health status, identifies barriers to care, sets
goals, coordinates care, and empowers members to self-manage
their conditions when appropriate.
Through this comprehensive program, we improve quality and reduce
preventable hospitalizations, avoidable readmissions and unnecessary
emergency room visits. First Choice
members like Robert and Senie
know about these benefits firsthand.
First Choice member
Senie is thankful for care
management to help manage
her chronic conditions.
Senie, from Moncks Corner, is the
primary caregiver for her two young
grandchildren. She has had several
heart attacks and lives with multiple and complex chronic conditions.
Senie had 10 inpatient hospital admissions in 2014, so Care Manager
Rhonda Cumbee, R.N., engaged
Senie in complex care management
and set her up with biometric telemonitoring. “Rhonda has helped
me a lot,” said Senie. “My blood
pressure was really high, and I was
scared. She talked to me like a true
friend and made me realize I wasn’t
the only one going through this. And
when I needed help understanding
my medicine, she explained the different drugs to me.”
Rhonda could see that Senie was
trying to improve her health, but
she didn’t have all of the information she needed to put the pieces
together. “I spoke with Senie several times about a low-salt diet,”
said Rhonda. “She insisted she
was watching what she ate but
couldn’t understand why she continued to gain weight and experience
shortness of breath. We had a
breakthrough when I realized she
was unaware that salt goes by another name: sodium.”
Rhonda added, “After speaking with
Senie many times, she was clearly becoming more empowered and
confident. Seeing her taking charge
of her own health care really motivated me, and, by helping her stay
out of the hospital, she has her life
and independence back. She is more
active, and her success will allow her
to continue to care for herself and
her grandchildren.”
“If it weren’t for Rhonda, I don’t
know what I would do. I would recommend First Choice to anybody,”
Senie said.
Robert, a 61-year-old member in
Salem, also deals with many conditions, including syncope (fainting)
and orthostatic hypotension (a form
of low blood pressure), as well as
asthma and chronic obstructive
pulmonary disease (COPD). “For
more than 10 years, I’ve been in bad
health. It sneaks up on you slowly,”
Robert said.
After talking to Care Manager
Dianna Morris, R.N., Robert was motivated to make an appointment
with his doctor, who went into action to address his illnesses. “He was
very sick, so I suggested he call his
primary care doctor right away,” said
Dianna. “I also educated him about
orthostatic hypotension, instructing
him to sit at the edge of his bed for
a few minutes when going from a
lying to standing position.”
continued
Care Management
First Choice member Robert is now
able to exercise and play with his
great-grandkids after participating
in care management.
Care Management
Our members, first and foremost
Over time, Dianna taught Robert
how to best manage his conditions through lifestyle changes and
medicines. “Dianna talking to me,
suggesting little things I could do,
really helped,” said Robert. “She
didn’t holler or tell me I had to do
something, and that made me want
to do it. I began to look forward to
her calls.”
Dianna even helped Robert quit
smoking. “She suggested that in the
morning, I wait five to 10 minutes
before I had a cigarette, and then,
little by little, I increased my wait
time,” he said proudly.
said Dianna. “He’s going to his
doctor appointments, taking his
medications as prescribed and walking every day. I was so happy to hear
he can now play outside with his
great-grandkids and has more energy than he’s had in a long time.”
Our complex care management
program is one of the ways we
help save the state millions of dollars each year, and members in the
program are grateful for the support. “Dianna was a miracle to me,
and I feel like I’ve been born again,”
said Robert. “I wouldn’t trade First
Choice for anything.” “Today, Robert sounds wonderful,”
Care Manager Rhonda Cumbee,
R.N., works with members who have
chronic conditions to help them
coordinate care and better manage
their health.
Care management has been
very beneficial for
my patients with
chronic conditions.
It provides extra
support to help
ensure they are
better managing
their health.
—Dr. Kirby Smith
Kirby Smith, M.D., at Parkwood
Pediatrics in Charleston has many
patients who have been helped by
First Choice care management.
Cost Avoidance
GREAT CARE IS THE FIRST
STEP IN MANAGING COSTS
Select Health emphasizes
education and outreach,
preventive care, and effective
disease management to help
improve health outcomes
and quality of life for South
Carolinians.
By providing the right care
in the right setting, Select
Health saved the state more
than $100 million during fiscal
year 2015 and more than
$480 million since 2010.
Wakely Consulting was
contracted by Select Health
of South Carolina to conduct
this cost avoidance study for
state fiscal years (SFYs) 2010
through 2015. Cost avoidance
figures are developed based on a
comparison of adjusted historical
per capita health care claims and
administrative costs for Medicaid
fee-for-service program members
against the actual capitation or
per capita fees paid to Select
Health. The difference between
the per capita claims costs and
the capitation amount paid to
Select Health is the estimated
cost avoidance achieved by
Select Health’s participation in
the managed Medicaid program.
South Carolina Department of
Health and Human Services does
not check or confirm third-party
statistics or data. To view the
Department’s annual Cost and
Quality Effectiveness Report for
Medicaid plans, visit www.scdhhs.
gov/reports-statistics.
Bright Start
First steps to care
Select Health’s First Choice plan
covered more than 23 percent
of all 57,631 births in the state in
20141 and covered more than 46
percent of the 29,772 babies born
within the South Carolina Healthy
Connections Medicaid program2.
Expectant mothers and young children comprise a majority of our
plan’s membership. To support
these key populations, we offer tailored programs to help moms-to-be
deliver full-term babies while staying healthy before, during and after
pregnancy.
To ensure women in South Carolina
receive regular prenatal care, which
increases the likelihood of delivering a healthy baby, we enroll
high-risk pregnant members into
our signature Bright Start® maternity program. Bright Start offers
specialized prenatal care management with a dedicated staff who
advocate for members and help
coordinate medical care and social
services throughout each member’s
pregnancy. The program works to
decrease infant mortality as well as
the number of babies born preterm.
These numbers in South Carolina
are currently well above the national
average and one of Select Health’s
leading concerns.
Once a woman enrolls in Bright
Start, a Select Health staff member
makes an introductory call to get to
know the expectant mother, as well
as her medical history, lifestyle and
general health. After this initial call,
we send a packet of educational information tailored to the expectant
mother’s specific needs. Bright Start
staff also work closely with local obstetricians to ensure the program
is providing information that complements their instructions. When
mom and baby return home from
the hospital, they continue to receive support from the program.
Reminders about vaccination schedules, well-child visits and flu shots,
and information about postpartum
depression and poison prevention
are provided throughout a baby’s
first year of life.
Select Health is dedicated to successful birth outcomes across South
Carolina. We play a key role in the
South Carolina Birth Outcomes
Initiative, a collaborative effort to
improve health outcomes for newborns in the Medicaid program
and throughout the state. We are
also the long-standing Premier
Prematurity Campaign Partner of
the South Carolina Chapter of the
March of Dimes.
Whether it is helping moms-to-be
make healthy choices and control
risk factors during pregnancy or educating new moms on well-child
care, Select Health is there every
step of the way to help ensure
healthy outcomes and happy families in South Carolina. 1. South Carolina Department of Health and
Environmental Control.
2. South Carolina Department of Health and
Human Services.
Bright Start
Care before and after
the first breath
After being diagnosed with
pre-eclampsia, a sudden increase
in blood pressure for pregnant
women, Allison (names have been
changed) delivered her firstborn son
prematurely. She worried herself
sick while her tiny baby remained
in the neonatal intensive care unit
(NICU) for several days before he
was released. Between her first
and second pregnancies, Allison
joined the First Choice health plan,
so when Allison’s obstetrician (OB)
determined she was at high risk
after experiencing contractions with
her second pregnancy and dilating 4 centimeters at just 29 weeks,
a care manager contacted Allison
immediately.
“Ideally, pregnant members with a
history of preterm delivery should
be followed closely and checked
often,” said Susan Gay, R.N., Allison’s
care manager. “The goal is to deliver
a baby after 38 weeks.”
Susan, as part of our Bright Start
program, worked closely with
Allison’s OB to manage the care
Allison needed to decrease the
likelihood of preterm labor. After
a short hospital stay and a series
of preventive treatments, Allison
was discharged with a prescription for Procardia®, a medication to
help relax the uterine muscle and
decrease contractions to prevent
further cervical dilation.
“She continued to have irregular
contractions over the next several
weeks, but they don’t always cause
cervical change. We talked often
about what she was feeling and what
she should do. For a member who
has experienced early delivery, this
can be an anxious and drawn-out experience. I was happy to be there for
Allison when she needed me.”
After several weeks of care management, Allison gave birth to her
second son, Ethan, at 36½ weeks.
Allison is just one of the many
mothers on the First Choice health
plan experiencing healthy outcomes
with the help of our Bright Start
program.
“This is the most satisfying part of
being a care manager,” Susan said.
“The outcome is certainly worth
the effort.” Timeliness of
prenatal care
91%
Frequency of ongoing
prenatal care
74%
55%
Postpartum care
between 21 and 56
days after delivery
76%
62%
(≥81% of expected visits)
Care Manager Susan Gay, R.N.,
works with members in our
Bright Start program.
82%
Select Health HEDIS 2015
HEDIS 2015 Medicaid
Quality Compass® mean
HEDIS
Putting children’s
health first
WELL VISITS
for adolescents
ages 12 to 21
ROSE 27%
from 2012 – 2014.
With nearly 75 percent of our
membership age 18 or younger, helping children grow into healthy adults
has always been a priority at Select
Health. To determine whether our
members are hitting their developmental milestones and staying
healthy, we recommend well visits
for all children from birth to age 21,
which encompass regular medical
checkups, growth and development
monitoring, nutrition and physical
activity education, dental checkups, and age-appropriate tests and
screenings. With our multifaceted
approach of outreach and member engagement, we are helping our
members attend a higher number of
well visits so they don’t miss out on
this vital part of preventive care.
Making every member contact
count
At Select Health, we believe in
meeting the members where they
are to ensure they get the care they
need. Throughout 2015, we educated members on and promoted
well visits through collaborations
across many areas of the company. Each week during the summer
months, our Member Services representatives made 7,000 phone
calls encouraging members to visit
Families in the Columbia area
received free health screenings
like eye exams at our annual
Jump-Start Back-to-School
event on July 25, 2015.
their doctors for their well visit
checkups. The Community Outreach
Solutions team went the extra mile
to visit members at their homes to
schedule appointments and arrange
transportation, eliminating barriers
a member may have had to keeping
his or her appointment.
Getting in gear for the new
school year
To further encourage well visits
for the whole family, Select Health
helped organize events like JumpStart Back-to-School, offering free
back-to-school information, health
screenings and children’s activities.
We even provided our adolescent
members with new backpacks full of
beneficial school supplies. Our sixth
annual back-to-school event was
held at the First Choice Community
Center in Columbia, with more than
50 community organizations offering support and health screening
services to more than 1,800 parents
and school-age children to ensure
our members were healthy and
ready for the upcoming school year.
Encouraging children to be
“First Choice Fit®”
Well visits are also supported
through our signature First Choice
HEDIS
It felt good to
play and make
a goal at the
First Choice Fit
football camp. I
was proud that I
could do it.
—First Choice
member Lucien
Fit campaign, which promotes preventive health care for youth. In 2015, we
teamed up with Buffalo Bills wide receiver Sammy Watkins to help us promote
healthy behaviors to our members.
“Well visits are important,” said Sammy.
“Everything might seem fine, but you
don’t know what’s going on inside your
body.”
Also in 2015, First Choice sponsored First
Choice Fit Marcus Lattimore football
camps, hosted by former San Francisco
49er and South Carolina Gamecocks running back Marcus Lattimore (pictured
on cover). These sessions were held
throughout the state as an incentive for
young members who completed their
well visits. “Being active helps so much,”
said Marcus, who advises our members
to “eat food that gives your body fuel.”
Catalina, a member in Taylors, is thankful for a health plan that supports her in
keeping her son healthy. Lucien, age 10,
participated in the First Choice Fit football camp with Marcus Lattimore. “It’s
phenomenal to have that support,” said
Catalina. Lucien gets regular checkups
“to make sure he’s healthy and that I’m
doing all I should. I feel really blessed and
lucky to have First Choice.”
continued
HEDIS
Putting children’s health first
Got Health?
Sumter Family Health Center
received our first Got Health award
for their efforts to complete well
visits for our members.
Football star Sammy Watkins explains
the importance of exercise, nutrition
and well visits to kids as part of our
First Choice Fit campaign.
Partnering with our providers is
another important component in
improving well visit rates. Sumter
Family Health Center, a federally qualified health center (FQHC),
was recognized in 2015 by our “Got
Health” initiative for its exemplary
efforts in completing well visits for
our members. The Center achieved
this recognition for their strategic outreach to pediatric patients
through targeted mailings and hiring a Doctor of Nursing Practice
(DNP) to focus on the transitional
young adult population, ages 12 to
30. “Got Health” encourages members to take charge of their health,
focusing on preventive health and
rewarding members with T-shirts for
engaging in healthy behaviors like
keeping current with well visits. The
program also partners with and recognizes community organizations
and provider offices as “Got Health”
champions for supporting members
in their efforts to be healthy.
Avenues to outreach lead to
positive results
Through our collaborative efforts,
Select Health is able to educate and
encourage members on the importance of preventive care and the
health benefits offered through our
health plan. To date, these efforts
have been proven to be successful. From 2012 to 2014, adolescent
well visit compliance among members ages 12 to 21 rose 27 percent.
Additionally, we have improved our
HEDIS results from 2014 to 2015,
increasing well visit rates for newborns, children ages 3 to 6 and
adolescents ages 12 to 21. With
continued participation from our
members and the invaluable support
we receive from providers, Select
Health can help ensure our members
get the care they need to stay well. Spotlight on values
Select Health associates value advocacy
Nominee: Brenda Curry, R.N., Clinical Care Reviewer, Utilization Management (left)
Nominated by Angela Price, R.N., Clinical Care Reviewer, Utilization
Management
“Brenda has made it her mission
to help children. As a clinical care
reviewer, Brenda reviews all types of
cases, and she is especially interested
in protecting child welfare. She is
dedicated to bringing medical and
provider staff together to strategize
ways to get appropriate education
and assistance to our members. We
have [unofficially] coined her mission
‘Brenda’s Kids.’ This is an example of
really taking your work to heart. Brenda
demonstrates how we can work
behind the scenes to advocate for our
members and hopefully change lives.”
Select Health associates value
stewardship
Nominee: Amy Rodriguez, Customer Service Representative, Member Services (left)
Nominated by Josue Valentin, Supervisor, Member Services
“Stewardship means caring for the
needs of one another, and Amy utilizes compassion and care to resolve
problems for our members. In particular, she recently went above and
beyond for a member who had just
been discharged from the hospital.
The member’s prescribed medications
required coordination with another primary insurance, which had ended. Amy
was able to correct the information
and follow up with the member to let
him know we processed his prescriptions. The member was very thankful
for Amy’s assistance and relieved to
know he could pick up his medicine.”
HEDIS
Checkups with
Primary Care Provider
ACHIEVING QUALITY
STANDARDS BY PUTTING
CARE FIRST
By educating and empowering
our First Choice members to
be involved in their health care,
59%
66%
64%
Newborns
(at least six well visits by 15 months)
we help improve their health
and overall quality of life.
HEDIS is a tool that measures
performance on important
dimensions of care and service
and is the most widely used
72%
68%
64%
Children ages 3 – 6
(at least one well visit per year)
performance measurement
tool in health care. Our most
recent results show that we
made many improvements
and exceeded the HEDIS 2015
Medicaid Quality Compass
mean in several areas.
50%
49%
50%
Teens and adolescents ages 12 – 21
(at least one well visit per year)
South Carolina Department of Health and
Human Services does not check or confirm
third-party statistics or data. To view the
Department’s annual Cost and Quality
Effectiveness Report for Medicaid plans,
visit www.scdhhs.gov/reports-statistics.
HEDIS 2015 Medicaid Quality
Compass mean
HEDIS
Chronic Conditions
Prevention and Screening
84%
90%
91%
Use of asthma medications
ages 5 – 64 years
54%
53%
51%
80%
65%
66%
Adult body mass index (BMI)
59%
62%
64%
Breast cancer screening (mammogram)
Diabetes retinal eye exam
Behavioral Health
66%
65%
Cervical cancer screening (Pap test)
52%
49%
46%
Antidepressant medication,
acute phase
(remained on medication at least 84 days)
33%
31%
60%
37%
Antidepressant medication,
continuation phase
55%
54%
54%
Annual chlamydia screening
(in women 16 – 24 years)
84%
71%
61%
Adolescent immunizations
(Combo 1 by 13th birthday)
(remained on medication at least 180 days)
22%
18%
13%
HPV vaccine
(three series by 13th birthday)
Member
First things first:
Identifying barriers to care
“I can’t tell you what a difference
this program has made for my husband, in his health and mood,” said
First Choice member Leo’s wife.
Community Care Connector Sam
Bellamy met Leo at his home
in Walterboro over a year ago.
As part of our Community Care
Management team, Sam reaches
out to members who have frequently used the emergency room or had
multiple hospitalizations and reconnects them to the plan and needed
services. He immediately noticed
Leo’s family was living in an older
mobile home desperately in need
of repair. The steps leading into the
home weren’t secured, there were
holes in the floor, and windows were
completely missing, which meant
the home wasn’t properly insulated
for heating or air conditioning.
“The [Community Care
Management] team has really
helped me improve my health,”
said First Choice member Leo.
Leo had worked as a mechanic but
had to stop due to many medical
setbacks, the most devastating of
which was the loss of his voice following a tracheotomy procedure
several years before. “The tracheostomy tube was uncomfortable for
him, and he really couldn’t talk, so
he would get frustrated,” said Sam.
“It also became clear there were issues with health literacy, and then
he shared with me that he couldn’t
read. Because of these communication issues, doctors wrote him off as
being noncompliant. I knew then he
needed our support to improve his
health and quality of life.”
The team began scheduling doctor
appointments and accompanying
Leo so he could reconnect with
providers. Leo also had trouble
filling medications; but, with the
team’s support, he began taking
his medications as prescribed. As
time went on, he started taking
pride in attending doctor appointments and celebrating each success,
and he built a deep trust with the
Community Care Management
team. “I know I’m connecting with
him when he opens up to me. Each
time we have a small victory, he’ll
tell me a story about his mother,”
said Sam.
The team worked with Leo to
demonstrate the benefits of relocating to a safer home more suited
to his health needs. He also rented the land where they were living,
which consumed most of his income. “It was a difficult decision
because they had been living there a
long time, but the more one-on-one
time we spent with him, the more
he realized there are people who
can help and make life a little better,” said Community Care Manager
Shanice Graham. Leo agreed to
apply for housing in Walterboro,
and, after several months, the family
moved into an apartment.
Shanice reached out to local resources, including Leo’s church,
which donated household items,
and a local furniture bank, which
provided chairs. The team also secured needed clothing vouchers,
food assistance, new eyeglasses
and emergency assistance for utilities. “Leo was overwhelmed with so
many issues hanging over his head,”
said Shanice. “By helping with some
basic needs, he began to have hope,
a reason to live and work toward
being healthy.”
For the first time, Leo started to
think about his future and changes he wanted to make for his life.
Nominee: Community Care Management Team (below)
Nominated by Shanice Graham, Manager, Community Care
Management
“Our team goes out into the community to reach the most difficult-to-engage members. We meet members where they are
and work side-by-side with them. In 2015, the team spent more
than 5,000 face-to-face hours with members and made over
5,000 calls to members reminding them of upcoming doctor
appointments and assisting with resources and emotional support. We’ve also touched the lives of others in the community
indirectly through the education and resources provided to
members who then pass it along to others in the community.”
Community Care
Connector Sam Bellamy
with member Leo.
He was very weak and using his wheelchair
more, so he and his wife decided he needed exercise. Integrated Care Manager Alice
LeBlanc, R.N., advocated for Leo to begin outpatient physical therapy, and he worked with
a therapist one to two times a week to lose
weight and become less dependent on the
wheelchair.
Also Nominated by Alice M. LeBlanc, R.N., Program Manager,
Community Care Management Team
“The Community Care Management team is the most dedicated group of caring people. Sit with them for a moment, and you
hear tremendously challenging reports of members dealing
with trauma and chaos. This team comes together to solve
problems. They advocate for our members every day and go
the extra mile for those most in need in our community to ensure members have holistic wellness support to get healthier.”
The couple became more comfortable setting
up transportation and doctor appointments
and began relying less on the Community Care
Management team to make these arrangements. As the team worked toward graduating
him from the program, Leo had one final request: to have his tracheostomy evaluated by
a new physician, since he was uncomfortable
and often had trouble breathing. “We arranged
for a doctor to see him,” said Sam. “She realized the tube was too long, and once she
changed the tube and adjusted it, he wasn’t in
pain and he could talk much better.”
Leo admits he was unsure of Sam when he
first showed up at his door but is now truly
grateful for all of the support and care from
the Community Care Management team.
“They’ve been really nice to me, and I am
feeling better now,” said Leo. “I’m definitely
thankful for First Choice and would recommend it to anyone.” Pictured from left to right: Community Care Connectors Kimberly Fennicks
and Sam Bellamy, Administrative Assistant Lisa Bryan, Medical Director Fred
Volkman, M.D., Community Care Connector Danielle Haynes, Program Manager
Alice LeBlanc, R.N., and Community Care Manager Shanice Graham.
Spotlight on values
care of the poor
Spotlight on values
Select Health associates value compassion
Nominee: Sandi Fort, R.N., Senior Care Manager, Integrated Care Management (left)
Nominated by Angela Valmus, R.N., Senior Care Manager, Integrated Care
Management
“Sandi is very compassionate about
helping our members live healthier lives. She puts her heart into her
work and takes her time listening
to our members. She seeks to plug
members into the right settings and
resources to help them better manage their health conditions, and the
members she works with benefit
tremendously from her knowledge
and compassion. With a background
as a nurse in the emergency room,
she also uses her skills to serve her
community, volunteering regularly at
her church and for many local events.”
Select Health associates value dignity
Nominee: Kimberley Wilson, Community Outreach Specialist, Quality Improvement (right)
Nominated by Belinda Butler, Community Outreach Specialist, Quality Improvement
“Kimberley has worked for the past 10
years to help our members stay well.
She links members with community
resources and providers and often
assists members by arranging health
screenings and doctor appointments
or helping them establish a medical
home. Kimberley also encourages
people at community health events
throughout the state to maintain a
healthy lifestyle. In her free time, she
volunteers to educate people about
various health disparities, especially
cervical cancer prevention. She is a
long-time supporter of the South
Carolina Witness Project, empowering African-American women to
get screened for breast and cervical cancers. Kimberley also works
with the South Carolina Chapter
of the National Cervical Cancer
Coalition and Cervical Cancer-Free
South Carolina, and in 2015 she
successfully petitioned Governor
Nikki Haley to proclaim January as
Cervical Cancer Awareness Month.”
CHOSEN FIRST BY SOUTH CAROLINA
PROVIDERS
Select Health of South Carolina maintains
an extensive and highly satisfied network
of more than 10,000 providers across
the state. Our providers are our partners,
and they are a critical component of our
ability to improve the health and wellness of our members and communities.
According to an independent provider
satisfaction survey, respondents rated
First Choice higher than other Medicaid
health plans across all main categories
of the survey. In addition, more than 90
percent of our providers indicated they
would recommend First Choice to their
patients and fellow providers.
Overall satisfaction
88%
76%
Claims reimbursement process
85%
77%
Pharmacy services
68%
61%
Network management/network operations
84%
76%
Provider claims services
82%
72%
Care management
84%
77%
More than nine in 10 of our providers
would recommend Select Health’s
First Choice plan to other practices,
providers and patients.
Utilization and quality management
81%
74%
Select Health
All other Medicaid plans
Provider Satisfaction
2015 Provider
Satisfaction Survey
Associate
Firsthand knowledge in caring
for our members
At Select Health, our priority is
the health and well-being of South
Carolinians. This passion has been
ingrained in our company and is a
direct result of our associates’ drive
to make a difference in the lives
of our members. Sometimes the
members we serve join our team of
associates, bringing a personal perspective to our work that helps us
better understand and serve our diverse membership.
while our associates’ passion and
expertise help members navigate
the often-complex health care system. From Medicaid recipients to
dedicated associates, the Nivenses
are proudly educating members and
the community about our plan. They
live our mission every day and are
familiar faces in the communities
we serve. “We love being able to
educate [members] on health and
wellness,” Walter said.
Walter Nivens, a community educator, and his wife, Marguerite,
a community events coordinator,
bring this unique perspective to the
work they do in the field every day.
Before joining the team at Select
Health, Walter and Marguerite were
Medicaid recipients themselves.
“When people tell us they’re embarrassed to be on Medicaid, we
understand,” Walter said. “We remind them that it’s a safety net for a
time of need.”
Associates like Walter and
Marguerite are part of the reason
First Choice is the health plan of
choice in South Carolina. Our staff
of over 500 associates is thankful
to contribute to the well-being of
the local community. Named one of
the “Best Places to Work in South
Carolina” for eight consecutive
years, Select Health has been made
successful by associates like Walter
and Marguerite, who truly put care
at the heart of their work. This firsthand knowledge helps
break down barriers and builds a
level of trust with our members,
Select Health associates Walter
and Marguerite Nivens provide
information about the First Choice
plan at a community event.
Spotlight on values
competence
Nominee: Eric Bell, Technical Support Analyst, Data and Technical Services (middle)
Nominated by Courtnay Thompson, Director, Plan Operations (right) and
Terry McMenamy, Director, Data and Technical Services
“Eric started as an intern with our
organization and was promoted to
technical support analyst. He performs
his job well with a positive attitude
and a smile on his face. Eric does not
say ‘that’s not my job,’ regardless of
whether it entails picking up trash in
a hallway or patiently walking a new
telecommuter through an installation.
Eric seeks ways to grow and learn
more in his role and demonstrates that
he is truly invested. He has offered several process improvement suggestions
and ideas, aims to make our company
more efficient, and is seen as a friendly
go-to person by his fellow employees.”
Select Health associates value diversity
Nominee: Jeanette Narvaez, Community Educator, Community Education (right)
Nominated by Tommie Myers, Community Events Coordinator, Community
Education
“Jeanette has served our members
for 10 years. She is a bilingual community educator and is looked upon
as a valuable resource to help ensure
we can communicate with our diverse
membership. Jeanette is passionate
about helping our Spanish-speaking
members and works hard to make
sure members understand how to use
our programs and services so they
stay healthy. She is also active in the
community and looks for events in
our area to help further our mission
of building healthy communities.”
CAHPS
Understanding is the first
step in care management
Making sure members have access
to high-quality health care is a top
priority at Select Health. We know
cultural competency is vital for our
members’ good health, and it is also
one of the ways we work to ensure
our members are satisfied. This is
evidenced by our strong CAHPS
results year after year. We also
maintain the highest retention rate
of Medicaid managed care plans in
the state, at 97 percent.
“Helping our Spanish-speaking
members get care is my passion,”
said Select Health bilingual Care
Manager Deanie Hess, R.N.
More than 10 years ago, Select
Health founded its Culturally and
Linguistically Appropriate Services
(CLAS) program. The program aims
to reduce health care disparities by
better understanding the unique
backgrounds and cultures of our
members and is guided by the national CLAS standards developed by
the U.S. Department of Health and
Human Services’ Office of Minority
Health.
Language services are an important
part of our CLAS program because
being able to communicate and
understand health information is
necessary for staying healthy. Silvia’s
son, Alex, is a First Choice member in Walhalla. When he recently
fractured his leg, she was relieved
to get help in Spanish. “I was very
worried, but I was so happy to have
someone I could talk to who could
help me figure out what to do.
Communication is the most important thing,” said Silvia.
“It’s important to understand someone’s culture,” said Eliza Varadi, M.D.,
at Pelican Pediatrics in Charleston.
Select Health bilingual nurse
Deanie helped Silvia understand
her son’s medicine and how to
take it. She also helped Silvia locate a wheelchair for her son from
a participating durable medical
equipment company close to Silvia’s
home. She then helped Silvia set up
physical therapy and transportation.
“It’s important to talk to someone in
their native language, especially as
a nurse. It shows that we really care
about them and their health,” said
Deanie. “I love helping people who
want to get care and stay healthy
but may not speak English.”
Our provider network also plays a key
role in our cultural competency efforts.
Dr. Eliza Varadi is a First Choice provider
at Pelican Pediatrics in Charleston who
speaks English, Spanish, Russian and
Hebrew. “Having come to this country
as an immigrant, I know how difficult it
is to navigate health care in a different
language and culture. The more I can alleviate that stress for my patients, the
better,” said Dr. Varadi.
Through these efforts and others,
Select Health is a three-time recipient of NCQA’s Multicultural Health
Care Distinction award. We are one
of 19 Medicaid health plans in the
Unites States and the first health
plan in South Carolina to earn this
distinction.
NCQA honors organizations that
meet or exceed its rigorous requirements for multicultural health care
and recognizes them as leaders actively working to provide programs
and services to advance health equity. Select Health’s efforts include
accessible written and oral language
services, specialized training for
employees and providers, and innovative programs aimed at reducing
health care disparities.
This distinction acknowledges our
commitment to providing members with culturally and linguistically
appropriate services, and we will
CAHPS
Communication
is the most
important thing.
—Silvia, mother of
First Choice
member Alex
continue working to remove cultural
barriers, knowing our members are
best served when we tailor our services to their personal preferences
and needs. C L A S
Culturally and Linguistically
Appropriate Services
A United Voice for Multicultural Health Care
CAHPS
2015 Member
Satisfaction Survey
FIRST LISTENING, THEN ACHIEVING
Each year, Select Health of South
Carolina uses the CAHPS survey,
a standardized national survey, to
measure member satisfaction with
health plan services as well as care and
services from our provider network.
The feedback we receive from our
members is extremely important to
us and helps guide our programs and
services. This chart highlights results
from our 2015 CAHPS survey, showing
we exceeded the CAHPS Quality
Compass 75th percentile in many of
the composite measures as well as the
overall rating measures.
Customer service
88%
Getting care quickly
89%
91%
90%
94%
92%
Getting needed care
88%
89%
Rating of health care
85%
Rating of health plan
84%
87%
91%
91%
93%
Rating of personal doctor
90%
94%
Select Health CAHPS 2015
Select Health CAHPS 2014
93%
Child CAHPS 2015 Quality
Compass 75th percentile
88%
Spotlight on values
Select Health associates value hospitality
Nominee: Tom Sommer, Account Executive, Provider Network Management (left)
Nominated by Mary Wasden, Account Executive, Provider Network Management
“I joined Select Health in May 2015, and
it was necessary to learn quickly so I
could successfully serve our providers.
Tom shared his expansive knowledge
of the organization and the provider network in a warm, friendly way.
He is truly dedicated to the mission
at Select Health and gives his all to
show exceptional service to a provider
group or a fellow associate. Having sat
next to Tom during my orientation, I
often overheard his interactions on
the phone and in person and quickly
followed his lead. Tom always stops
to help a fellow associate or provider with a pleasant tone and manner.”
Select Health associates put our mission
into action
Nominee: Cassandra Moultrie, Coordinator, Appeals (right)
Nominated by Missy Pye, Clinical Systems Project Lead, Medical Management
Systems
“Cassandra is committed to helping people get care, stay well and
build healthy communities. She has
worked on the Rapid Response and
Outreach Team, contacting members
who needed help setting up doctor
appointments and transportation, and
I know members were thankful for
her quick and dedicated assistance.
Outside of work, she spends much of
her time in her community and with
youth at her church. From an early
age, she has cared for others. As the
oldest of seven children, she helped
her mom raise her siblings, and she
graduated from college at age 26
while caring for her two children. Her
passion is mentoring youth, many of
whom are attending college because
of her guidance and persistence.”
Community
To be an inspiration, you
must first set an example
Actions speak louder than words.
At Select Health, care is the heart
of our work, and we demonstrate
that by giving back to the community. More than 20 years ago,
AmeriHealth Caritas Regional
President and Select Health Founder
Mike Jernigan established the
precedent for dedicated service by
volunteering at various civic and
health care-related organizations. His
passion for improving the quality of
life in the state’s communities continues to inspire associates to advance
the mission of making a difference
by helping people get care, stay well
and build healthy communities.
AmeriHealth Caritas Regional
President and Select Health Founder
Mike Jernigan is President of the
Coastal Carolina Fair, which raises
money for local nonprofits.
Mike is especially interested in partnering with organizations to improve
the lives of children. He is a past
president of the Exchange Club of
Charleston, which supports efforts
to prevent child abuse and promote youth achievement. Currently,
he is president of the Coastal
Carolina Fair, which generates
more than $800,000 annually for
local Charleston area charities, including Darkness to Light and the
Dee Norton Lowcountry Children’s
Center.
Empowering youth to reach
their full potential
Following Mike’s lead in advocating for children, we have a tradition
at Select Health of volunteerism
and service to child-serving agencies. One example is our work with
the Charleston-based nonprofit Be a Mentor (BAM). Mentors are
paired with students for weekly onehour visits during the school year.
Receiving one-on-one attention
from a reliable adult is a rarity for
many of these students.
BAM offers five signature programs
at local schools. There is Lunch
Buddies for elementary school students, Project Shine to help middle
school students with goal setting
and academics, and Career Path
Community
Mentoring for high school students.
In addition, Basics Boosters helps
students achieve grade-level proficiency in subjects like reading and
math, while After-school Academic
Mentoring is offered to students at
the Carolina Youth Development
Center.
“[My mentee’s] teacher told me
[BAM] has made a world of difference, not only in test scores, but in
her attitude toward school. Having
two children of my own, I know how
important early education is to get
children started on the right track.
[My mentee] doesn’t get a lot of individual attention at home, so I’m
glad I can be there for her.”
—Donette Gibson, compliance specialist, Select
Health, mentor to a third-grade student
Delivering hope and healing in
times of greatest need
In serving the health care needs of
Lowcountry residents, Select Health
has witnessed the power of families
and communities coming together to find solutions. As a long-time
supporter of the Ronald McDonald
House Charities of Charleston, we
know it can change lives.
Select Health Compliance
Specialist Donette Gibson
volunteers at Charleston’s Be a
Mentor program to help kids who
need a little extra support.
Select Health is one of seven recognized business partners of the
Ronald McDonald House Charities
of Charleston. Our donations support the organization’s Share a
Night program, which helps cover
operating costs (estimated at $75
per night per family) so families can
stay close to their children being
treated at Medical University of
South Carolina.
continued
Community
To be an inspiration, you must first set an example
Since 80 percent of the families
who stay at Ronald McDonald House
are Medicaid beneficiaries, this particular partnership is a very special
opportunity for us to build healthy
communities one family at a time.
Moving one stroke closer to a
cure
Another cause near and dear to the
hearts of the Select Health team is
supporting cancer research and survivorship programs.
“Select Health understands more
than most organizations the importance of our mission of keeping
families close. In addition to the
monetary support, Select Health
employees come to the House to
volunteer, collect wish list items
and participate in our fundraising
events.
Last year, we were corporate sponsors of the annual Dragon Boat
Charleston. Due to the generosity
of festival sponsors, 100 percent of
all paddlers’ donations went toward
cancer research, as well as survivor
education programs focusing on
healthy lifestyles and nutrition.
“Our business partners are part
of the Ronald McDonald House
Charities family. They not only educate their employees about the
work we do, but help raise awareness within the entire community
of the challenges families can face
when a child requires a lengthy
hospitalization.”
—Alix Robinson Tew, Director of Development,
Ronald McDonald House Charities of Charleston
CHARLESTON, SC
Select Health is a long-time
supporter of the Ronald McDonald
House of Charleston, where families
can stay while their children undergo
extensive medical treatment.
Here’s how one rower on our 2015
“Seas the Day” team described the
experience.
“The Dragon Boat Festival is a wonderful day with family and friends.
I was very excited to be on Select
Health’s first festival team and loved
the fact that Select Health was a
corporate sponsor. Sponsorship
spearheads a variety of community programs, which are such an
Community
important part of Dragon Boat
Charleston’s mission. It also helps
survivor teams go to other boating
events, including international races.
“During the festival, there is a moment when the survivors come
together. It’s a time to remember
those we lost over the past year, but
also a time to reflect on how dragon boating empowers us on and
off the water. It’s like, OK, it’s been
tough dealing with cancer, but now
it’s time to get back on the water.
That’s where we’re strong.
“For me, there’s just something
about being in that boat. I look
around and see some people who
are still going through treatment
who are out there paddling. I see
that dragonhead while we’re racing.
I have a sense that whatever comes
my way, I know I can handle it.”
—Cynthia Smalls, Clinical System
Administration, Select Health Select Health’s “Seas the Day”
team participated in Charleston’s
Dragon Boat Festival, which
raises money for cancer research
and cancer survivors.
I have a sense
that whatever comes
my way, I know I can
handle it.
—Select Health associate
Cynthia Smalls
Featured on front cover:
Marcus Lattimore, former
University of South
Carolina running back,
has been promoting
prevention as part of our
First Choice Fit campaign,
which encourages kids to
get their yearly well visits.
Select Health of South Carolina is a member of the AmeriHealth Caritas Family of Companies.

Annual Message to the Community - Select Health of South Carolina

Transcription

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